Abstract
ObjectiveWe aimed to assess outcomes [rates of recovery, default, case fatality; rate of weight gain and rate of Mean Upper Arm Circumference (MUAC) gain] of children aged 6–59 months with severe acute malnutrition (SAM) at the Outpatient Therapeutic Center at Gado Refugee Camp, Cameroon, in relation to international standards. We retrospectively analysed files of 254 children with SAM aged 6–59 months admitted from April 2015 to August 2016.Results72.8% got discharged as recovered, 0.8% died and none defaulted. 26.8% got referred to stabilization center, mostly for poor weight gain (44.1%). Mean rate of weight gain was 4.4 g/kg/day and MUAC gain 0.3 mm/cm/day; median duration of treatment 44.5 days. Amongst those with marasmus, kwashiorkor and marasmic kwashiorkor, median duration of stay was 48, 24.5 and 36.3 days (p = 0.002); recovery rates were similar 73, 71.4, 71.4% respectively (p = 0.7); Median rates of weight gain, 4.4, 6.7 and 8.1 g/kg/day (p = 0.05). 49 children had been incorrectly diagnosed and treated as SAM. International Standards were met in terms of case fatality rate and default rate but not rates of recovery and weight gain. Separate gender charts must be used to calculate weight for height z scores as combined charts cause significant errors.
Highlights
20 million children under 5 years suffer from severe acute malnutrition (SAM) [1], mostly in SubSaharan Africa and South Asia [1,2,3]
This study aimed to retrospectively assess the outcomes [Rates of weight gain (RWG), rates of recovery, default rate and case fatality rate (CFR)] for a cohort of children aged 6–59 months diagnosed with uncomplicated SAM and followed up at the Gado Outpatient Therapeutic Center (OTC) from April 2015 to August 2016, in relation to Sphere guidelines
As the OTC used combined gender growth charts, z-scores calculated by the OTC differed significantly from those calculated by authors using the same values for weight and height
Summary
Validity of data The OTC did not record admission WHZ for 29 of the 254 cases though weight and height had been recorded for these. Mean overall rates of weight gain and MUAC gain were 4.4 ± 4.4 g/kg/day and 0.3 ± 0.3 mm/cm/day respectively (Table 1). For those who had recovered, rate of weight gain was 5.6 g/kg/day. Comparisons were made between children discharged as cured and those referred to the stabilization center, and while there was no significant difference in age, WHZ, height and weight for age z-scores, those who were cured had longer duration of treatment [50 days versus 26.5 days (p < 0.001, CI − 23.6 to − 10.5)], rate of weight gain [5.6 versus 1.3 g/kg/ day (p < 0.001, CI − 5.4 to − 3.2)] and rate of MUAC gain [0.3 versus 0.1 mm/cm/day (p < 0.001, CI − 0.3 to − 0.2)] (Table 1).
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